Association between Surgeon-Patient Race and Gender Concordance and Patient-reported Outcomes Following Breast Cancer Surgery

Abstract Purpose: Surgeon and patient-related factors have been shown to influence patient experiences, quality of life (QoL), and surgical outcomes. We examined the association between surgeon-patient race- and gender-concordance with QoL after breast reconstruction. Methods: We conducted a retrospective cross-sectional analysis of patients who underwent lumpectomy or mastectomy followed by breast reconstruction over a 3-year period. We created the following categories with respect to the race and gender of a patient-surgeon triad: no-, intermediate-, and perfect-concordance. Multivariable regression was used to correlate post-operative global (SF-12) and condition-specific (BREAST-Q) QoL performance with patient-level covariates, gender- and race-concordance. Results: We identified 375 patients with a mean (±SD) age of 57.6±11.9 years, median (IQR) body mass index of 27.5 (24.0, 32.0), and median morbidity burden of 3 (2, 4). The majority of encounters were of intermediate concordance for gender (70%) and race (52%). Compared with gender discordant triads, intermediate gender concordance was associated with higher SF-Mental scores (b, 2.60; 95% CI, 0.21 to 4.99, p=0.003). Perfect race concordance (35% of encounters) was associated with significantly higher adjusted SF-Physical scores (b, 2.14; 95% CI, 0.50 to 4.22, p=0.045) than the race-discordant group. There were no significant associations observed between race- or gender-concordance and BREAST-Q performance. Conclusions: Race concordant relationships following breast cancer surgery were more likely to have improved global QoL. Perfect gender concordance was not associated with variation in QoL outcomes. Policy-level interventions are needed to facilitate personalized care and optimize breast cancer surgery outcomes.